Method for clinician house calls utilizing portable computing and communications equipment

ABSTRACT

Mobile clinicians conduct in-home patient visits utilizing on-site diagnostic and treatment equipment, where service is enhanced by the use of portable computing and communications equipment. Initially, a mobile care entity provides a network of predesignated mobile clinicians, each having the use of a preprogrammed portable computer. Each computer is coupled to a wireless communications device, and includes local storage of patient data. Under a predetermined schedule, each portable computer updates patient data in the local storage utilizing the wireless communications device to download updates from a central storage facility. Whenever the mobile care entity receives requests for medical service at a patient&#39;s premises, the entity selects a mobile clinician and dispatches him/her to the patient&#39;s premises. The clinician visits the patient&#39;s premises accompanied by an assortment of electronic diagnostic and treatment devices, such as a pulse oximiter, x-ray machine, lab analyzer, EKG equipment, etc. To examine the patient, the doctor utilizes various diagnostic devices to prepare machine-readable reports of related aspects of the patient&#39;s condition. The clinician directs the portable computer to perform follow-up tasks including: (1) electronically collecting the prepared reports and graphically presenting them in human-readable form, (2) storing a machine-readable medical record including details of the patient&#39;s exam, and (3) utilizing the wireless device to transmit the reports and records to the central storage facility.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to the provision of medical servicesthrough clinicians' “house calls.” More particularly, the inventionconcerns a method providing a network of mobile clinicians thatindividually conduct in-home patient visits utilizing on-site diagnosticand treatment equipment, where service is enhanced by the use ofportable computing and communications equipment.

2. Description of the Related Art

With the current American healthcare situation, many sick patientsencounter difficulty when attempting to access a physician's office.Some of these difficulties include restrictions on the number or type ofhealth maintenance organization (HMO) visits, limitations of visits tocertain preselected physicians, scheduling difficulties, transportationand parking challenges, slow or non-existent insurance reimbursement,and the like. Aged, infirm, or other homebound patients are faced withthe particularly difficult challenge of transporting themselves to aphysician's office to receive medical attention. Even for ambulatorypatients, the current setup can be frustrating to the patient, due tothe need to schedule an appointment far in advance.

In contrast to the traditional doctor's office, urgent care centers aregeared toward minor, ambulatory emergencies and generally provideoffice-level care on a walk-in basis. For non-ambulatory patients, theemergency room provides similar barriers to availability as a personalphysician's office. Whether ambulatory or not, many patients report astrong aversion to visiting this typically expensive, uncontrolled,slow-moving environment, even among those with a serious medical need.Additionally, gatekeeper triage of acute medical conditions can leavethe patient feeling abandoned and the physician feeling that she hastaken a measurable risk with the patient's outcome. Nonetheless, thereare still more than one hundred thousand visits to American emergencyrooms annually. And, even though more than eighty percent of emergencyroom visits are not necessary to save life and limb, this is sometimesthe only alternative for patients requiring prompt service.

As one alternative to visiting an emergency room or a personalphysician, some patients call “911” to dispatch an ambulance, especiallyfor medical conditions that are perceived to be particularly serious.Nonetheless, the fanfare and cost of ambulance services can be excessivefor many ultimately non-serious medical conditions that typically promptpatients to call an ambulance.

In contrast to the options of meeting a personal physician, visiting anemergency room, or calling an ambulance, many people would prefer toreceive acute care in their home or workplace. In fact, the concept ofrendering acute care in the home or workplace was the fundamental basisof healthcare for more than four thousand years until the mid-1950s. Inthe past forty years, however, the concept has fallen out of favor. Infact, between 1960 and 1975, the number of house calls made by familypractitioners decreased by seventy-five percent to approximatelyseventeen million. In 1989, only one million house calls were billed toMedicare. Physicians stopped-making house calls because of many reasons,including inadequate reimbursement, perceived liability, and questionsabout the quality of care. Each of these concerns is enhanced whendealing with acutely ill patients.

Due to these and other unsolved problems, then, patients' options forobtaining prompt, convenient, acute medical care are not completelyadequate today.

SUMMARY OF THE INVENTION

Broadly, the present invention concerns a method of providing medicalcare, in which mobile clinicians conduct in-home patient visitsutilizing on-site diagnostic and treatment equipment, where service isenhanced by the use of portable computing and communications equipment.Initially, a mobile care entity provides a network of predesignatedmobile clinicians. The mobile care entity provides each clinician withuse of a preprogrammed portable computer, called a “clinician device.”Each clinician device is coupled to a wireless communications device andincludes local storage of patient data.

According to a predetermined schedule, each clinician device updatespatient data in the local storage by utilizing the wirelesscommunications device to download updates from a central storagefacility. As an example, this may occur during off-hours on a dailybasis, or another appropriate schedule. The mobile care entity receivesrequests for mobile service to be rendered at a patient's premises.These requests may originate directly from the patient, or from areferral source such as a personal physician, a health careorganization, etc. In response to the request for service, the mobilecare entity selects one of its predesignated mobile clinicians anddispatches the selected clinician to the patient's premises.

The clinician visits the patient's premises accompanied by an assortmentof electronic medical care devices, such as a pulse oximeter, x-raymachine, laboratory analyzer, cardiac output monitoring equipment, etc.The clinician examines the patient, which may include selecting andoperating one or more of the on-site medical care devices to analyze oneor more aspects of the patient's condition and prepare representativeoutputs. Beneficially, the clinician device may also interact withoff-site diagnostic devices, utilizing a communications interface toaccess remotely located diagnostic equipment that is unsuitable fortransportation to the patient's premises due to size, expense, etc.Then, the clinician directs the clinician device to perform variousoperations, including (1) electronically collecting the medical caredevice outputs and presenting them in human-readable form, (2) storing amachine-readable medical record including details of the clinician'sexamination of the patient, and (3) utilizing the wirelesscommunications device to transmit the machine-readable reports andmedical records to the central storage facility.

The foregoing features may be implemented in a number of differentforms. For example, the invention may be implemented to provide a methodto render on-site medical care. In another embodiment, the invention maybe implemented to provide an apparatus, such as a portable computerprogrammed to assist the on-site clinician as discussed herein. In stillanother embodiment, the invention may be implemented to provide asignal-bearing medium tangibly embodying a program of machine-readableinstructions executable by a digital data processing apparatus toperform operations as discussed herein. Another embodiment concernslogic circuitry having multiple interconnected electrically conductiveelements configured to perform operations as discussed herein.

The invention affords its users with a number of distinct advantages.Importantly, the provision of in-home medical services enhances the bondbetween patient and doctor, as the doctor enters the patient's home andreceives the patient's trust. Also, the provision of on-site medicalservices saves time of busy people, since they can avoid having to driveto the hospital and wait for medical attention and prescription filling.This invention also enables doctors to save money by avoiding thesubstantial overhead costs of maintaining traditional medical offices.Patients also save money by receiving at-home care rather than hospitalcommitment, ambulance services, or emergency room visits. This inventionis especially useful for elderly or other infirm patients that simplycannot travel to the doctor's office. Also, in non-life threateningcases, the invention helps non-ambulatory patients obtain medical carewithout the flashing lights, sirens, costs, and other excessiveattributes of ambulance service. By providing in-home care, the methodof this invention also encourages more rapid discharge of patients aftersurgery. As another benefit, the invention can be used to provideon-site medical services for sporting events, air shows, beaches, andother public gatherings. The invention also provides a number of otheradvantages and benefits, which should be apparent from the followingdescription of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram of the hardware components andinterconnections of an in-home medical care environment, according tothe invention.

FIG. 2 is a block diagram of a digital data processing machine accordingto the invention.

FIG. 3 shows an exemplary signal-bearing medium according to theinvention.

FIG. 4 is a flowchart of a patient call initiation sequence, accordingto the invention.

FIG. 5 is a flowchart of an automatic call initiation sequence,according to the invention.

FIG. 6 is a flowchart of a clinician notification sequence, according tothe invention.

FIG. 7 is a flowchart of an on-site patient diagnosis/treatmentsequence, according to the invention.

FIG. 8 is a flowchart of a mobile care setup sequence, according to theinvention.

DETAILED DESCRIPTION

The nature, objectives, and advantages of the invention will become moreapparent to those skilled in the art after considering the followingdetailed description in connection with the accompanying drawings.

Hardware Components & Interconnections

In-Home Medical Care Environment

One aspect of the invention concerns a system for dispatching medicalservices, which may be embodied by various hardware components andinterconnections. This system is illustrated, along with other relatedcomponents, utilizing the exemplary operating environment 101 of FIG. 1.The operating environment 101 includes the patient's home 100, a callcenter 110, clinician device 140, on-site medical care devices 185, theInternet 200, and various secondary components 130-137. Generally, thecall center 110 receives and processes requests for in-home medicalvisits to patients. Medical services are provided at the patient's home100, which may be equipped with various devices for monitoring andreporting the patient's condition, as shown below. The clinicianutilizes the computer-based clinician device 140 to aid in conductinghouse calls, as explained in greater detail below. As further describedbelow, the secondary components 130-137 include other related componentssuch as remote diagnostic equipment, records storage, third parties,Internet web sites, local hospitals, billing facilities, etc.

In the environment 101, employees or other agents of a “mobile careentity” screen and process incoming calls, dispatch clinicians, storerecords, process billings, and perform other services related to theproviding of on-site medical care. The mobile care entity may comprise acorporation, non-profit group, partnership, sole proprietorship, orother suitable organization.

Patient's Home

Central to the provision of in-home medical services (“house calls”) isthe patient's home 100, workplace, relative's home (not the patient's),restaurant, mall, sporting event, or any other place where the patientdesires to receive medical attention. For ease of reference, this placeis referred to as the patient's “home” 100. However, the site 100 is notlimited to the patient's living quarters, although this may constitutean illustrative embodiment.

Although the invention contemplates clinicians making self-supportedhouse calls without requiring any equipment at the patient's home 100,the mobile care entity may optionally pre-equip the home 100 withvarious electronics. For example, the patient's home 100 may be equippedwith a telephone 102 for use by the patient in placing calls to the callcenter 110, and also for use by on-site clinicians. Moreover, thepatient's home 100 may also include an internet capable communicationdevice 104, such as a personal computer, web-enabled phone, web-TV, etc.As explained below, the device 104 may serve the patient's requests formedical attention, as well as by on-site clinicians' need to gatherinformation, file reports, etc. The patient's home 100 may also includean internet-capable medical device 106, which comprises one or moremachines capable of monitoring the patient's medical condition andtransmitting representative reports by the Internet 200, administeringmedication or other treatment pursuant to remotely transmitted commands,etc. As an example, the device 106 may comprise heart monitoringequipment, dialysis machinery, blood pressure monitoring equipment,respiratory equipment, etc. A custom device programmed to contact themobile care entity may also be installed at the patient's home 100.

In one embodiment, one or more of the telephone 102, communicationdevice 104, medical device 106 are interconnected to one another other.

Call Center

The mobile care entity operates the call center 110 to receive requestsfor in-home patient visits. Alternatively, the mobile care entity mayhire a subcontractor to perform the services of the call center 110. Thecall center 110 includes a telephone bank 112, triage processing block114, clinician location block 116, pre-scheduled appointment informationblock 120, and wireless clinician paging system 118. In one embodiment,one or more of the telephone 112, triage processing block 114, clinicianlocation block 116, appointment information block 120, and paging system118 are interconnected to one another.

Depending upon whether the blocks 114-120 are implemented with humans orcomputers, the telephone bank 112 may be implemented by traditionaltelephones (used by humans), or automated switching equipment(compatible with computers). The triage processing block 114 includespersonnel and/or equipment trained or programmed to receive incomingcalls, assess whether the reported medical condition is appropriate fortreatment by mobile care entity's clinicians. The mobile care facilitymay field some conditions appropriate for emergency room treatment, suchas influenza, broken bones, non-life threatening abrasions, etc. Thetriage processing block 114, however, refers life-threatening conditionsto more appropriate ambulance, life-flight, or other critical careservices.

The clinician location block 116 includes personnel and/or equipmenttrained or programmed to identify appropriate clinicians and dispatchthem to serve incoming requests. The clinician location block 116 mayoperate based on geographic proximity, time availability, and otherconsiderations. Once identified, the clinician is paged, called, orotherwise contacted by the wireless clinician paging system 118, whichincludes personnel and/or equipment that is appropriately trained orprogrammed for this purpose. As described below, clinicians may becontacted via their clinician devices 140. In one embodiment, theclinician location block 116 receives input from the clinician devices140 as to the clinician's current geographic location. The clinicianlocation block 116 stores this information for reference at the time ofdispatch.

The pre-scheduled appointment information block 120 includes personneland/or equipment trained or programmed to maintain schedules for themobile care entity's network of clinicians. Thus, the block 120 may beimplemented by scheduling software, physical calendars, or acombination.

Clinician Tools

In addition to operating the call center 110, the mobile care entityhires, contracts, or otherwise maintains a network of mobile cliniciansthat are available on a full-time, part-time, on-call, or other basis.The mobile care entity provides each clinician with access to aclinician device 140 and a selection of “clinician tools” for on-sitepatient diagnosis/treatment, billing, and record keeping. Broadly, theclinician tools include a host of diagnostic and treatment devices,including the on-site medical care devices 185 along with the typicalaccoutrements of a family physician.

As explained below, each of the medical care devices 185 includes awireless (as illustrated) or non-wireless communications interface withthe clinician device 140. Although the precise details may varydepending upon the application, the devices 185 may include thefollowing items, which may be conveniently stored in a van or othermeans of transportation: electro cardiograph machine, pulse oximeter,laboratory analyzer, x-ray machine, and the like.

The clinician tools also include other devices without any wirelessinterface, such as a stethoscope, tongue depressor, thermometers, bloodpressure cuff, splints, casts, bandages, sutures, syringes, and othertypical equipment of an emergency room, family physician, etc.Furthermore, the clinician may arrive at the patient's house equippedwith a mini-pharmacy, constituted by a representative selection of mostcommonly prescribed drugs. The clinician's tools may further includeequipment for performing a broad range of diagnostic procedures andtests, including urinalysis, blood count/chemistry,cholesterol/triglyceride analysis, splinting fractures and broken bones,biopsies, suturing lacerations, constructing casts, pregnancy tests,visual acuity tests, draining abscesses, foreign body removal, pregnancytests, and the like.

As mentioned above, the clinician also arrives at the patient's home 100with a portable computer, represented by the clinician device 140. Themobile care entity provides each clinician with access to a cliniciandevice 140. To save costs, clinicians with different working hours mayshare the same clinician device 140. In one embodiment, each cliniciandevice 140 includes, in one or more housings, a wireless interface 142,mapping device 144, medical records 146, wireless interface 148 fordiagnostic equipment, human interface 150, and location device 152,although other embodiments may omit one or more of these. In oneembodiment, one or more of these components are interconnected with oneanother.

In one embodiment, the wireless interface 142 comprises a digitalcellular telephone capable of accessing the public Internet 200. As analternative or additional feature, the interface 142 also include asystem to receive pages and/or wireless telephone calls, such as pagingmessages from the wireless clinician paging system 118. The locationdevice 152 comprises self-locating device such as a global positioningsystem (GPS) engine, long range navigation (LORAN) module, OmniTRACSsystem, radio frequency receiver, inertial navigation system, etc. Thelocating device 152 cooperates with mapping device 144 hardware andsoftware to display maps to assist the clinician in reaching thepatient's home 100. Although the mapping device 144 may include mappingsoftware, the clinician device 140 may utilize the interface. 142 toaccess mapping software available through the Internet 200 or otherremote site. The medical records 146 comprise a medical records databasethat is frequently synchronized with patient data contained in themedical record center 130. The wireless interface 148 utilizes Bluetoothtechnology, infrared, RF, spread spectrum, or other wireless interfaceto conduct data exchange between the clinician device 140 and wirelesscomponents of the on-site diagnostic equipment 185.

The clinician device 140 also includes a human interface 150 data entry,which may include a keyboard, digitizing pen, voice interface, mouse,touch-operated input device, a combination of the foregoing, or otherappropriate device(s).

Internet & Secondary Components

As mentioned above, the system 101 also includes a number of secondarycomponents 130-137, with a variety of functions. These secondarycomponents 130-137 as well as the patient's home 100, call center 110,and clinician's device 140 are selectively linked by an appropriatenetwork such as the public Internet 200 (as shown), intranet, wide areanetwork, token ring, etc. The selective linking between these componentscorresponds to the nature of interaction between components, which isdescribed in greater detail below.

The secondary components 130-137 include a medical record center 130,remote medical care devices 132, web server 133, third party vendors131, interested third party with access authorization 134, medicalinformation web site 135, local hospital admissions 136, and a billingentity 137. Each of these components has a different type and extent ofinformation exchange with other parts of the system 101, as shown below.Additional secondary components may also be incorporated into theenvironment 101, depending upon the particular needs of the application.

The medical record center 130 comprises a server, workstation, massstorage device, or other appropriate facility to store medical recordsfor patients of the mobile care entity. The medical record center 130may be co-located with the call center 110, for example. As one example,the medical record center 130 may provide access to stored medicalrecords through an Internet web site utilizing password checks,firewalls, encryption, or other suitable guarantees of patient security.This information, along with any other information to be shared, may beprovided by the web server 133. Depending upon the implementationrequirements, communications may be expedited by integrating the webserver 133 with one or more other components such as the call center110, medical records center 130, etc.

The remote medical care devices 132 represent diagnostic and/ortreatment equipment located remotely from the patient's home. Thedevices 132 include computer or other electronic communicationcomponents for exchanging information with the on-site clinician and theclinician device 140. Despite their remote location from the patient,the devices 132 are therefore available to diagnose/treat the patient.As illustrated, communications between the remote devices 132 and theclinician device 140 is relayed by the Internet 200. The devices 132 mayinclude equipment that is expensive, bulky, movement-sensitive, unique,or otherwise unsuitable for transportation to the patient's home. Someexamples include a T_(c)O₂ machine, End Tidal Capnometer, PulmonaryFunction Machine, and the like.

The third party vendor 131 represents an entity such as a home healthagency, durable medical equipment manufacturer, or health maintenanceorganization. The vendor 131 may have reason to communicate with the webserver 1.33, medical record center 130, clinician (via clinician device140) or other clinical components for the purpose of fulfilling HealthCare Financing Administration billing requirements, communicatingmedical info to the physician or receiving medical info, for example.

The interested third party with access authorization 134 represents anentity such as a patient's personal care physician, close friend,partner, or relative with a valid reason to access the medical records130 to monitor the patient's treatment. In the illustrated embodiment,the third party 134 may access the medical records 130 via the Internet200.

The medical information web site 135 represents various Internet websites with reference information that is helpful to mobile careclinicians. The clinicians may access these web sites during on-sitepatient visits, for example using the patient's internet capablecommunication device 104, or by using the wireless interface 142 featureof the clinician device 140. Clinicians may also access such web sitesafter patient visits, for the purpose of performing any follow-upresearch and diagnosis. Although some content may be provided by themobile care entity through its web server 133, the web sites 135 arechiefly operated by independent content providers supplying referenceand other medical information.

The local hospital admissions 136 represents an admissions desk or othersimilar facility in a hospital. Communications with the admissions 136may be helpful, for example, to aid the on-site clinician in admittingthe patient to a hospital. Furthermore, hospital admissions 136 may havereason to communicate with the medical record center 130, clinician (viaclinician device 140), and other clinical components for the purpose ofmedical records review, discharge planning or coordinating levels ofservice.

The billing entity 137 represents an entity such as a contracted billingagency, in-house billing staff, automated billing service or software,etc. The entity 137 may have reason to communicate with the clinical andadministrative components or the environment 101 for the purpose ofgenerating Health Care Financing Administration compliant bills,reviewing utilization experience or analyzing trends.

Exemplary Digital Data Processing Apparatus

Another aspect of the invention concerns a digital data processingapparatus, which may be used to implement the clinician device 140 andother components with data processing functions. This apparatus may beembodied by various hardware components and interconnections;.oneexample is the digital data processing apparatus 200 of FIG. 2. Theapparatus 200 includes a processor 202, such as a microprocessor orother processing machine, coupled to a storage. 204. In the presentexample, the storage 204 includes a fast-access storage 206, as well asnonvolatile storage 208. The fast-access storage 206 may comprise randomaccess memory (“RAM”), and may be used to store the programminginstructions executed by the processor 202. The nonvolatile storage 208may comprise, for example, one or more magnetic data storage disks suchas a “hard drive,” a tape drive, or any other suitable storage device.The apparatus 200 also includes an input/output 210, such as a line,bus, cable, electromagnetic link, or other means for the processor 202to exchange data with other hardware external to the apparatus 200.

Despite the specific foregoing description, ordinarily skilled artisans(having the benefit of this disclosure) will recognize that theapparatus discussed above may be implemented in a machine of differentconstruction, without departing from the scope of the invention. As aspecific example, one of the components 206, 208 may be eliminated;furthermore, the storage 204 may be provided on-board the processor 202,or even provided externally to the apparatus 200.

Logic Circuitry

In contrast to the digital data storage apparatus discussed previously,a different embodiment of the invention uses logic circuitry instead ofcomputer-executed instructions. Depending upon the particularrequirements of the application in the areas of speed, expense, toolingcosts, and the like, this logic may be implemented by constructing anapplication-specific integrated circuit (“ASIC”) having thousands oftiny integrated transistors. Such an ASIC may be implemented with CMOS,TTL, VLSI, or another suitable construction. Other alternatives includea digital signal processing chip (“DSP”), discrete circuitry (such asresistors, capacitors, diodes, inductors, and transistors), fieldprogrammable gate array (“FPGA”), programmable logic array (“PLA”), andthe like.

Operation

Having described the structural features of the present invention, themethod aspect of the present invention will now be described. Althoughthe present invention has broad applicability to medical care, thespecifics of the structure that has been described is best suited forproviding a network of mobile clinicians that individually conductin-home patient visits enhanced by the use of portable computing andcommunications equipment, and the explanation that follows willemphasize such an application of the invention without any intendedlimitation.

Signal-Bearing Media

In the context of FIG. 1, such a method may be implemented by operatingthe clinician device 140, call center 110, medical record center 130, orother components (each as embodied by a digital data processingapparatus 200) to execute respective sequences of machine-readableinstructions. In each case, these instructions may reside in varioustypes of signal-bearing media. In this respect, one aspect of thepresent invention concerns a programmed product, comprisingsignal-bearing media tangibly embodying a program of machine-readableinstructions executable by a digital data processor to perform a methodof rendering mobile medical care as described below.

As a specific example, this signal-bearing media may comprise, forexample, RAM (not shown) contained within the clinician device 140, asrepresented by the fast-access storage 206. Alternatively, theinstructions may be contained in another signal-bearing media, such as amagnetic data storage diskette 300 (FIG. 3), directly or indirectlyaccessible by the processor 202. Whether contained in the storage 206,diskette 300, or elsewhere, the instructions may be stored on a varietyof machine-readable data storage media, such as direct access storage(e.g., a conventional “hard drive,” redundant array of inexpensive disks(“RAID”), or another direct access storage device (“DASD”)), magnetictape, electronic read-only memory (e.g., ROM, EPROM, or EEPROM), opticalstorage (e.g., CD-ROM, WORM, DVD, digital optical tape), paper “punch”cards, or-other suitable signal-bearing media including transmissionmedia such as digital and analog and communication links and wireless.In an illustrative embodiment of the invention, the machine-readableinstructions may comprise software object code, compiled from a languagesuch as “C,” etc.

Logic Circuitry

In contrast to the signal-bearing medium discussed above, the methodaspect of the invention may be implemented using logic circuitry,without using a processor to execute instructions. Logic circuitry maybe implemented in the clinician device 140, call center 110, medicalrecord center 130, or other components, where the logic circuitry itselfis configured to perform operations to implement the method of theinvention. The logic circuitry may be implemented using many differenttypes of circuitry, as discussed above.

Operating Sequences

FIGS. 4-8 provide one illustrative, detailed example of the methodaspect of the invention. For ease of explanation, but without anyintended limitation, the examples of FIGS. 4-8 are described in thecontext of the hardware components and interconnections of FIG. 1, asdescribed above.

Mobile Care Setup

FIG. 8 shows a mobile care setup sequence 800, where use and operationof the mobile care environment 100 is initiated. The sequence 800 beginsin step 802, where the mobile care entity establishes its network ofclinicians. The mobile care entity may construct this network byfull-time or part-time hiring of clinicians, enrolling independentcontractors, contracting with other agencies, or other suitablerelationships. Clinicians may include physicians, specialists such asdermatologist, x-ray technicians, nurses, nurse practitioners,physicians' assistants, paramedics, E.M.T. personnel, or other suitablemedical care providers. In step 804, the mobile care entity provides theclinicians with the clinician devices 140, described above. Eachclinician has access to at least one of the clinician device 140 whileon-duty; clinicians may also have access to clinician devices 140 whileon-call if the budget and number of clinician devices 140 permits.

In step 806, clinician devices 140 individually utilize their respectivewireless interfaces 142 to self-initiate downloading of patient recordsfrom the medical record center 130. To maintain current local records146, each clinician device 140 automatically repeats the synchronizationstep 806 whenever an appropriate criteria is met. This criteria mayrequire a periodic, non-periodic, random, or other sufficiently frequentsynchronization. The clinician devices 140 may be programmed tosynchronize at the same or different times. Synchronization helps theclinician devices 140 preserve the currency of their medical records146. However, if the number and size of medical records does not permitdownloading of all data from the medical records center 130, thesynchronization 806 may be limited to certain patients (such as thosescheduled for future visits by clinicians associated to the particulardevice 140), medical records of prescribed recency/type, etc. As analternative, the timing and extent of each clinician device'ssynchronization may be manually controlled by a clinician.

Patient Call Initiation

FIG. 4 shows a patient call initiation sequence 400. In the sequence400, a patient requests medical attention from the mobile care entity,and the call center 110 responds by selecting and dispatching aclinician from its network. The sequence 400 begins in step 402, wherethe patient enters the mobile care facility's web site (supported by theweb server 133). In this example, the patient initiates step 402 byusing the internet capable communication device 104. As an alternative,the patient may initiate the sequence 400 manually by using thetelephone 102 to contact a call center telephone 112, in which case thecall processing and triage operations are performed manually by staff(not shown) at the call center 110. For ease of explanation, thefollowing description is limited to the embodiment where automatedequipment at the call center 110 processes the patient's call.

Upon receiving initial access by the patient in step 402, the web server133 queries the patient for name, password, or other indicia thatidentifies the patient as an existing customer of the mobile careentity. Having identified the patient, the web server 133 proceeds togather information from the patient as to his/her medical condition(step 404). Namely, the patient answers certain predetermined “triage”or screening” questions, which may include a series of interactiveinquiries based upon the appropriate triage algorithm. In oneembodiment, the patient answers these inquiries by mouse-clicking onalternative choices, entering typed text, etc.

Next, the web server 133 forwards the patient's triage answers to thetriage processing block 114 (step 406), which determines whether thereis enough information to process the patient's call (step 408). If not,the triage processing block generates additional inquiries (step 410)and returns to step 404. When the triage processing block 114 determinesthat the patient has provided sufficient information to proceed (step408), the triage processing block 114 determines whether the patient'scondition presents a life-threatening situation (step 412). In oneembodiment, the triage processing block accesses medical informationstored locally or via Internet 200 in order to determine the outcome ofthe triage process. If the patient's condition constitutes alife-threatening situation, the triage processing block 114 directs theweb server 113 to display a message instructing the patient to obtainemergency ambulance services, for example by dialing “911” (step 414).Thus, the call center 110 refuses the patient's call, since it is moreappropriate for ambulance or other rapid deployment services rather thanan on-site clinician visit.

If the patient's situation is not an emergency, step 412 leads to step416, where the triage processing block 114 retrieves the patient'smedical records. The medical records may be retrieved from a third partyvendor 131 (such as the patient's primary care physician), from themedical record center 130, locally from the call center 110, or anothersource. Moreover, the records may be retrieved by hand, over theInternet 200, by facsimile machine, or other automated or manual means.

Next, in step 418 the triage processing block determines the appropriateclinician type and equipment required to treat the patient's reportedcondition. As mentioned previously, clinicians may have qualificationsof various levels, such as nurses, nurse practitioners, physicians,x-ray technicians, and the like. In one exemplary case, an appropriateclinician/device may be a nurse qualified to take blood (clinician) anda blood analyzer (device). In a different case, an appropriateclinician/device may be a physician (clinician) accompanied by an x-raytechnician (second clinician) and x-ray machine (device). Some examplesof other clinician/device combinations include cardiologist, andimpedance monitor, ultrasound machine and technologist, and otherspecialists. As one example, step 418 may be performed by utilizing asoftware module such as an expert system.

After the triage processing block 114 identifies the appropriate type ofclinician for the current patient (step 418), the clinician locationblock 116 identifies (step 420) and thereby selects a clinician in themobile care entity's network to satisfy the requirements of cliniciantype from step 418. This may be performed by consulting a look-up tableor other cross-referencing guide, for example. Some exemplaryconsiderations for step 420 include (1) the urgency of the patient'srequest, (2) the geographical location of both patient and candidateclinician, (3) the clinician's status as being on-duty busy, on-dutyidle, on-call, off-duty but available, (4) the clinician's pre-scheduledappointments available from the pre-scheduled appointment informationblock 120, etc. Step 420 may select multiple clinicians if required,such as an x-ray technician visit at one o'clock and then a physicianfollow-up visit at two o'clock.

The wireless clinician paging system 118 then transmits a dispatchnotification to the selected clinician, including forwarding ofsufficient information to the clinician to initiate the house call (step422). This information identifies the patient's name, the patient'saddress and telephone number, the reported medical condition, and otherinformation needed to initiate the house call. Further information mayinclude, for example, call center instructions resulting from patienttriage/interview, information on the patient's reported condition, callpriority, proposed or promised arrival time, etc. This information maybe conveyed to the clinician by various means, such as (1) the callcenter 110 transmitting a message to the Internet 200 for subsequentretrieval by the clinician, wireless internet connection, (2) standardcellular telephone or paging system, (3) standard wireless pagingsystem, (4) proprietary wireless system such as NEXTEL, or (5) othersuitable means. The on-call clinician receives this information athis/her clinician device 140, via the wireless interface 142.

In step 424, the triage processing block 114 responds to the patient'sinitial call (from step 402) by providing the patient with certainfollow-up information, such as the name of any clinicians that have beendispatched, proposed arrival time, etc. The block 114 may convey thisinformation to the patient by telephone 102, e-mail, updating aconfidential patient status area on the web site 133, etc. Furthermore,the triage processing block 114 may transmit e-mail or other suitablemessages to other interested parties, or make such information availableto parties with access authorization 134. Such parties may include, forexample, the patient's primary care physician, pre-registeredfriends/relatives, those with e-mail addresses entered by the patientduring initial registration with the mobile care entity, insuranceproviders, etc. This completes the sequence 400.

Automatic Call Initiation

FIG. 5 shows an automatic call initiation sequence 500. In the sequence500, automatic equipment installed at the patient's home requestsmedical attention from the mobile care entity, and the call center 110responds by selecting and dispatching one or more clinicians from itsnetwork. The steps are initiated in step 502, where the internet capablemedical device 106 transmits notification to the triage processing block114. This notification can take various forms, such as a periodicreport, an emergency request automatically generated in response to acondition such as dangerously low blood pressure, manually generatedemergency request such as the patient's manual activation of a “panicbutton,” etc.

In response to the notification of step 502, the triage processing block114 determines whether the notification contains sufficient informationto begin the process of dispatching a clinician (step 504). If not, thecall center 110 initiates a request for additional information (step505). In one example, this request may occur manually, by call centerstaff placing a telephone call to the patient. In another example, thetriage processing block 114 may submit a machine-initiated request foradditional information, for example by querying the medical device 106.

When there is sufficient information to process the notification of step502, the triage processing block 114 determines whether the patient'ssituation constitutes a life-threatening emergency. If so, the callcenter 110 directs the patient to obtain emergency medical care (step508), for example by dialing “911.” If the notification of step 502arose from the patient activating a panic button, step 508 may besatisfied by call center 110 staff contacting the patient by telephone102 or calling an ambulance on behalf of the patient. On the other hand,if the notification of step 502 arose from the medical device 106, step508 may involve the triage processing block 114 returning an automatedmessage to the medical device 106 or calling an ambulance on behalf ofthe patient.

If the present situation does not constitute an emergency, the triageprocessing block 114 retrieves the patient's medical record (step 510).The medical records may be retrieved from a third party vendor 131 (suchas the patient's primary care physician), from the medical record center130, locally from the call center 110, or another source. Moreover, therecords may be retrieved by hand, over the Internet, by facsimilemachine, or other automated or manual means.

Next, in step 512 the triage processing block 114 determines whether anyresponse by an on-site clinician is required. This step is performed byevaluating the notification (from step 502), any additional information(from step 505), and the patient's medical record (from step 510). Theevaluation of step 512 may be performed, for example, by using an expertsystem software module, or performing pre-programmed comparison with alist of various conditions for which clinician dispatch is required. Ifclinician dispatch is not needed, the patient is contacted and advisedaccordingly. Namely, call center 110 staff may manually contact thepatient, or the triage processing block 114 may automatically contactthe patient by sending an appropriate message to the medical device 106and/or the device 104.

On the other hand, if step 512 mandates clinician dispatch, the triageprocessing block 114 proceeds with step 516. Particularly, the block 114determines the appropriate clinician type and equipment required totreat the patient's reported condition, and then the clinician locationblock 116 identifies and thereby selects an on-call clinician in themobile care entity's network to satisfy these requirements. The wirelessclinician paging system 118 then transmits a dispatch notification tothe selected clinician, including forwarding of sufficient informationto the clinician to initiate the house call (step 518).

In step 520, the triage processing block 114 responds to the originalnotification of step 502 by providing the patient with certain follow-upinformation, such as the name of any clinician(s) scheduled to visit thepatient and the proposed arrival time(s). This completes the sequence500.

Clinician Notification

FIG. 6 shows a clinician notification sequence 600, where the clinicianreceives dispatch notification from the call center 110 and respondsaccordingly. The steps are initiated in step 602, when the cliniciandevice 140 receives the call center's dispatch notification (transmittedpreviously in steps 422 or 518, as discussed above). As mentioned above,this information identifies the patient, the reported medical condition,and other information needed to initiate the house call, and may includefurther information such as diagnosis/treatment instructions or allergyalerts resulting from patient triage/interview, information on thepatient's reported condition, call priority, proposed arrival time, etc.

In response to the dispatch notification from step 602, the mappingdevice 144 component of the clinician device 142 consults the locationdevice. 152 to determine the clinician's current location (step 604).Also in step 604, the mapping device 144 prepares a map including theclinician's present location (from the device 152), the patient'slocation (from the call center's dispatch notification), and appropriatedriving directions between these sites.

Next, in step 606 the clinician device 140 transmits a message reportingthe location of the clinician device 140. To aid the call center 110 inmonitoring the clinician's progress toward the patient's home, locationreporting messages may be repeatedly transmitted to the call center 110in response to: (1) occurrence of a repeating time period, such as oneminute, (2) call center queries, (3) significant changes in clinicianlocation, or (4) another reason.

After step 606, the clinician device 140 retrieves the patient's medicalrecords. This is performed by operating the interface 142 to contact themedical record center 130 via the Internet 200, and retrieving thepatient's most updated medical records. Also, the clinician device 140updates any locally stored medical records 146 with the currentinformation from the medical record center 130. Alternatively, ratherthan actively obtaining the patient's medical records, the cliniciandevice 140 may receive unsolicited transmission of the patient's medicalrecords by the call center 110. After step 608, the sequence 600 iscomplete and the clinician is ready to render on-site patient care uponarrival.

On-Site Patient Diagnosis/Treatment

FIG. 7 shows the sequence for on-site patient diagnosis/treatment, asperformed by the clinician. The sequence 700 begins in step 702, whenthe clinician visits the patient's home 100 after having been dispatchedas discussed above. The clinician is accompanied by the clinician device140, on-site electronic medical care devices 185, and other cliniciantools as discussed above.

In step 704, the clinician examines the patient. The clinician selectsand operates various of the clinician's tools to conduct theexamination. With traditional, manually-operated tools such asthermometers, blood pressure cuffs, and the like, use and feedbackoccurs in traditional fashion. The clinician may enter data from suchmanual examination into the clinician device 140 for inclusion into thepatient's medical record and/or analysis by diagnostic programs of theclinician device 140.

In contrast to traditional examination means, the clinician may performmore automated examination by coupling appropriate sensors between oneor more on-site electronic medical care devices 185 (such as alaboratory analyzer) and the patient's proximity, body, bodily fluids,or tissue, whereupon the device(s) 185 analyze the bodily componentunder scrutiny and provide a representative output. In one case, theoutput may comprise a human-readable output medical care devices 185present directly to the clinician. In other cases, the output of one ormore of the devices 185 may comprise a machine-readable output presentedto the clinician device 140; in this embodiment, the clinician device140 and device 185 communicate by the wireless link 148, although othermeans may be used as well such as infrared link, cables, fiber opticlines, etc. If the output of the device 185 is machine-readable, thenthe clinician device 140 collects this output and responsively providesa table, graph, diagram, or other human-readable presentation bycomputer display, printing, etc.

In addition to using on-site clinician tools, the clinician may alsoemploy one or more remotely located medical care devices 132. For thispurpose, the clinician couples sensors between the clinician device 140and the patient's proximity, body, bodily fluids, or tissue. The sensorsmeasure various physiological conditions and relay representativeinformation in machine-readable form to the clinician device 140. Inturn, the clinician device 140 invokes the wireless interface 142 tofurther relay these measurements to the remote device(s) 132, retrieveany resultant analysis from the remote devices, and locally present theresults for the clinician in human-readable form.

In step 706, the clinician manually enters data from the patient'sexamination, and also utilizes the clinician device 140 to store theoutput of the devices 185/132, whether such output occurs in human ormachine-readable form. Furthermore, the clinician may direct theclinician device 140 to store any human-readable reports that it hasprepared utilizing machine-readable output of the devices 185. Ifdesired, the clinician may direct the clinician device 140 to transmitresults from the diagnosis (including output from devices 185) to thecall center 110 for immediate evaluation by another clinician, forinclusion in the patient's medical record by call center personnel, etc.

As shown in step 708, the clinician may supplement his/her evaluation ofthe patient's condition by utilizing the clinician device 140 andwireless interface 142 to access various medical information web sites135 or other sources of information about drug interactions, symptoms,treatment strategies, etc. After step 708, the clinician then diagnosesthe patient (step 710) and renders any on-site treatment (step 712), ifpossible. The clinician may immediately prescribe and render medicinethat s/he has brought along, as well as dispatch any available medicalproducts, such as slings, casts, sutures, bandages, etc. As for medicineor products that are not immediately available, the clinician may chooseto order them (step 714) from a third party vendor 131. Advantageously,the order may be placed in immediately using the clinician device tocontact the third party vendor 131 via the Internet 200. Such productsmay include walkers, special beds, oxygen, leased medical equipment, andthe like.

Next, in step 716, the clinician prepares a record of the at-homepatient visit by assembling the clinician's notes, reports from theclinician device 140, output from the equipment 185/132, and the like.The clinician stores a machine-readable representation of this record,for example in the medical records 146. At this time, or later, theclinician invokes the wireless interface 142 to transmit themachine-readable representation of the patient's report to the medicalrecord center 130.

Having completed the patient's visit, the clinician then performsvarious follow-up steps 718. For instance, on behalf of the patient, theclinician may utilize the clinician device 140 to complete an on-lineadmission process to a local hospital 136 if the patient's conditionwarrants. The clinician may also schedule one or more follow-up visitsby manually contacting call center personnel, or by utilizing theclinician device 140 and wireless interface 142 to notify thepre-scheduled appointment information block 120 with follow-upinformation. In addition, the clinician device 140 may transmit ane-mail message to a friend, relative, personal care physician, or otherpre-identified party after completion of the clinician's at-home visit.This e-mail message, which may be transmitted automatically by theclinician device 140 or manually by the clinician, contains informationreporting the patient's examination, diagnosis, and treatment. At thistime, the clinician may also receive, review, and respond to any e-mailmessages that have been forwarded by the call center 110 from anyinterested third parties 134. Other possible follow-up action includesvarious billing matters, such as transmitting messages to invoke thebilling entity 137, sending completed Health Care FinancingAdministration records to a referring home health agency, etc. Moreover,such billing operations may be performed automatically at the completionof the patient's visit, or by the clinician's use of the cliniciandevice. Finally, the clinician utilizes the clinician device 140 tonotify the call center 110 that the visit is complete.

OTHER EMBODIMENTS

While the foregoing disclosure shows a number of illustrativeembodiments of the invention, it will be apparent to those skilled inthe art that various changes and modifications can be made hereinwithout departing from the scope of the invention as defined by theappended claims. Furthermore, although elements of the invention may bedescribed or claimed in the singular, the plural is contemplated unlesslimitation to the singular is explicitly stated. Additionally,ordinarily skilled artisans will recognize that operational sequencesmust be set forth in some specific order for the purpose of explanationand claiming, but the present invention contemplates various changesbeyond such specific order.

1. A method of providing medical care, comprising operations of: amobile care entity providing a network of predesignated mobileclinicians; the mobile care entity providing the clinicians with use ofpreprogrammed portable computers, each portable computer coupled to awireless communications interface and including local storage of patientdata; according to a predetermined schedule, each portable computerupdating patient data in the local storage by utilizing the wirelesscommunications interface to download updates from a central storagefacility; the mobile care entity receiving a request for medicalservices at a patient's premises, and responsive thereto, selecting oneof the predesignated mobile clinicians and dispatching the selectedclinician to the patient's premises; the clinician visiting thepatient's premises accompanied by a preselected collection of electronicmedical care devices; the clinician examining the patient, includingselecting and operating one or more of the medical care devices toanalyze one or more aspects of the patient's condition and preparerepresentative outputs; the clinician directing the portable computer toperform follow-up operations comprising: electronically collecting theoutputs and presenting them in human-readable form; storing amachine-readable record including observations from the clinician'sexamination of the patient; and utilizing the wireless communicationsinterface to transmit the machine-readable record to the central storagefacility.
 2. The method of claim 1, the medical care devices includingat least one of the following: an x-ray machine; a cardiac outputmonitoring machine; laboratory analyzer; a pulse oximeter.
 3. The methodof claim 1, the operations further comprising: the clinician treatingthe patient; and the clinician directing the portable computer to storea machine-readable record including a summary of the clinician'streatment of the patient.
 4. The method of claim 1, the wirelesscommunications interlace comprising a mobile digital telephone.
 5. Themethod of claim 1, the wireless communications interlace comprising ananalog radio frequency transceiver.
 6. The method of claim 1, theclinician further directing the portable computer to perform operationscomprising: directing the portable computer and wireless communicationsinterface to transmit selected machine-readable reports and records to apatient referral source;
 7. The method of claim 1, the operationsfurther comprising: each portable computer tracking and recordingvarious event times related to the patient visit, including at least oneof the following: dispatch time, travel time, patient visit time.
 8. Themethod of claim 1, the downloading of updates from the central storagefacility being performed, via the public Internet.
 9. The method ofclaim 1, the operation of utilizing the wireless communicationsinterface to transmit the machine-readable record to the central storagefacility comprising: transmitting the record to the central storagefacility via the public Internet.
 10. The method of claim 1, theoperation of the clinician examining the patient further comprising: theclinician interconnecting one or more sensors between the patient andthe portable computer; the clinician directing the portable computer togather machine-readable representations of bodily conditions measured bythe sensors, and transmit the representations via the wirelesscommunications interface to a remotely located electronic medical caredevice; and the portable computer communicating with the remotelylocated device to obtain a machine-readable output representing analysisperformed by the remotely located device.
 11. The method of claim 13,the operation of obtaining, a machine-readable output representinganalysis performed by the remotely located device further comprising:the portable computer presenting the results in human-readable form tothe clinician.
 12. The method of claim 1, the operation of the clinicianexamining the patient further comprising: the clinician directing theportable computer and communications interface to cooperatively engagein machine-readable communications with a remotely located electronicmedical care device to report bodily conditions of the patient to theremotely located device and receive analysis based thereon.
 13. Themethod of claim 12, the remotely located electronic medical care deviceincluding an ultrasound machine.
 14. The method of claim 1, theoperations further comprising: the clinician directing the portablecomputer and communications interface to obtain information provided byInternet web sites.
 15. The method of claim 1, the operations furthercomprising: while at the patient's premises, the clinician utilizing theportable computer to place orders for medical supplies over theInternet.
 16. The method of claim 1, the operations further comprising:the operation of receiving a request for medical services at a patient'spremises comprising the mobile care entity receiving patient medicalinformation transmitted by a medical device located at the patient'spremises.
 17. The method of claim 1, the dispatching of the selectedclinician to the patients premises including sending wireless dispatchinformation tithe selected clinician, including patient medical recordinformation, current medical condition information, and patient locationinformation.
 18. The method of claim 1, the operations furthercomprising: responsive to the request for medical services, transmittinga machine-readable notification of the request to a pre-registeredparty.
 19. The method of claim 1, the operations further comprising:responsive to the request for medical services, transmitting amachine-readable response to the patient including at least one of thefollowing: posting a message upon an Internet web site, transmitting ane-mail message.
 20. The method of claim 1, the operations furthercomprising: responsive to the request for medical services, transmittinga machine-readable notification of at least one of the following to thepatient: geographic location of the selected clinician, and expectedarrival time of the selected clinician at the patient's premises. 21.The method of claim 1, the operations further comprising: responsive tocompletion of the clinician's visit to the patient, conducting automaticcomputer-driven operations including generating and transmitting ane-mail notification to a pre-registered party.
 22. The method of claim1, the operations further comprising: responsive to completion of theclinician's visit to the patient, conducting automatic computer-drivenoperations including: scheduling of a follow-up visit; and transmittingmachine-readable notification of the scheduled follow-up visit to apre-registered party.
 23. The method of claim 1, the operations furthercomprising: automated medical-condition monitoring equipment at thepatient's premises generating and transmitting the request for medicalservices to the mobile care entity.
 24. The method of claim 1, thefollow-up operations further comprising: the clinician operating theportable computer to prepare and make wireless transmission of one ormore orders for items related to the examination for delivery to thepatient.
 25. The method of claim 1, the follow-up operations furthercomprising: the clinician operating the portable computer to prepare andmake wireless transmission of information to admit the patient to ahospital.
 26. A computer-driven clinician device, comprising: a wirelessInternet-access device; a medical care device interface; local storage;a digital data processor coupled to the device, interface, and localstorage, the processor being programmed to perform operationscomprising: activating the Internet-access device to synchronize patientdata contained in the local storage with data from a remotely locatedmedical records database according to a predetermined schedule;utilizing the interface to receive machine-readable outputs fromelectronic medical care devices representing analysis of a patient'smedical condition; directing the local storage to store a medical recordincluding the machine-readable outputs; and operating theInternet-access device to transmit the medical record to a remotelylocated storage facility.
 27. The device of claim 16, where theinterface is being a wireless interface.
 28. The device of claim 16, theprocessor being further programmed to perform operations comprising:receiving machine-readable sensor output representing bodily conditionsof the patient; and employing the Internet-access device to transmit thesensor output to one or more remotely located electronic medical caredevices and request analysis of the output by the devices.
 29. Thedevice of claim 16, the operations further comprising: receiving awireless dispatch notification from a remotely located call center. 30.The device of claim 16, further comprising: mapping and locationcomponents programmed to identify a geographical location of theclinician device and prepare a map with directions to a prescribedpatient visit site.
 31. A method of patient-treatment comprising:receiving wireless dispatch information concerning a patient includingcurrent location information, current medical symptoms, and historicmedical records; following said location information to locate and treatsaid patient according to said wireless dispatch information; enteringmedical treatment information in response to patient treatment; andwirelessly transmitting said medical treatment information to a centrallocation.
 32. The method of claim 31, further comprising wirelesslyordering delivery of medication for said patient.
 33. The method ofclaim 31, further comprising wirelessly ordering delivery of medicalequipment for said patient.
 34. The method of claim 31, wherein saidmedical treatment information comprises a request to automaticallyschedule a follow-up visit for said patient.
 35. The method of claim 31,further comprising wirelessly contacting a predetermined party as tosaid medical treatment information via e-mail.
 36. The method of claim31, further comprising wirelessly transmitting admission information foradmitting said patient to a hospital.
 37. The method of claim 31,further comprising sending wireless notification of a current clinicianlocation.